Sanjay: Bahar maidan mein khel rahi hai, football ke liye ladai kar rahi aur humarein muhn lag rahi hai. (They are playing outside in the field, fighting for the football with us, and talking back to us.)

Me: In teeno mein se, aapko dikkat kis baat se hai? (Out of these three things, what bothers you the most?

Sanjay: Sabhi se hai. Humko teeno ki hi aadat nahi hai na. (All three of them. We are not used to such behaviour of girls.)[1]

On any given day, I would argue with him incessantly, making it very clear that the problem is not with the girls but with him. But, that day, I let him have the last word. Not because I had nothing to say to him, but because I felt a great sense of achievement and pride on behalf of the girls who had upset him and had challenged the patriarchal order and structure which is his comfort zone. He is visibly upset with the young girls in his village who have begun to question his authority. There are many other such men and boys in other villages as well, where the girls have begun to occupy and reclaim spaces like public grounds, which have traditionally been seen to be “male-only” spaces. They are angry, upset, and disturbed by this sudden demand for space by the girls.

The increasing number of female bodies in a playground, running, playing, jumping, laughing, and fighting is upsetting norms, challenging controls, and transforming spaces. These are bodies that are meant to be invisible inside and not visible outside in public spaces. These are bodies that are meant to be monitored and controlled inside homes, those four-walled bastions of patriarchy. In this established order, how they choose to dress, choose to roam, choose to express, and choose to interact with others is not their decision. However, now in small and not-so-small ways, these structures of power, of domination and silencing are being challenged. While some men and boys are not very happy with this overt display of female bodies in the field, there are others who are being supportive and encouraging of this trend. Some react angrily, some positively, and some violently.

It is not just the men and boys who are curious about what is happening. When sessions on topics like bodily changes, menstruation, sex, pregnancy, choice, consent, pleasure, rights, and autonomy are held as part of the It’s My Body programme, many mothers accompany their daughters to these meetings to check what is being ‘taught’. The local health workers are keen to participate in sessions on health, hygiene, nutrition, and menstruation. Sessions on sex, sexuality, choice, consent, and pleasure make them uncomfortable. The discomfort is not just at their end.

We also share this anxiety in talking about these issues freely and openly. The fear of backlash and antagonism makes us choose our strategies, messages, mediums and language strategically and carefully. The title of the programme, ‘It’s My Body’, when translated into Hindi— Mera Sharir, Mera Adhikaar, comes across as ‘bold’ or ‘radical’ and there is some hesitation in using it, both on our part as well as that of organisations co-implementing this programme with CREA[2]. The programme is very often projected as a programme on Reproductive Health, and the ‘S’ and ‘R’ in Sexual and Reproductive Health and Rights are used cautiously. Words like ‘hak’ , ‘adhikaar’, ‘pasand’, ‘anand’ ,’yaunikta’ (right, preference, pleasure, and sexuality)are used selectively and only in certain ‘safe’ settings and spaces. But, what happens, when these conversations are translated into actions outside these constructed ‘safe’ spaces?

When Rashmi (name changed),from Jharkhand, insisted on wearing jeans in the village, her mother pulled her out of the programme. Neha (name changed) has refused to marry the boy her parents chose for her because she doesn’t like the way he looks. Her parents are shocked and unhappy with this new assertion of her right to say ‘NO’. Kavita(name changed ) slapped the boy who grabbed her hand at the tea shop. The first thing that she had to explain to her parents, family, and others was – why was she roaming outside the house in the evening? Sunita, Mamta, and Jyoti (names changed ) come to attend these meetings on their bicycles. Some boys hide behind the trees place thorn traps on the way to puncture their bicycles, so that they can trouble and tease them. As a result, the girls have stopped staying back for volleyball practices in the evening and head home before it gets dark.

There are several question marks and circumscriptions outside of these ‘safe’ settings, where girls feel ‘empowered’, informed, and confident. All our conversations and discussions in these spaces and the choices girls make often have repercussions. What is the kind of resistance they face outside these safe spaces? How do they negotiate with those who are not part of this ‘safe’ space? How do they retain this confidence when they are outside this setting? What are the struggles they face to be a part of this group? Why is it that if something goes wrong, it is the girls who have to back down? Why does the fear of harassment, abuse, and violence hold them back from participating in these collectives?

The fear of the consequences for some of these young girls, who are questioning, challenging, and transforming the established social order, is ever-present. This compels us to reflect on our own strategies. We often ask ourselves whether we should tone down the rhetoric? Or should we let this fight run its own course? How do we make our processes of change more inclusive to include others who serve either as gatekeepers or as allies in this process? Creating exclusive, rights affirming and safe spaces for women and girls is necessary. But is that enough when the application of these rights is in the “real world”?

Sanjana Gaind works at CREA as Program Coordinator – Young Women’s Feminist Leadership. Sanjana is interested in the application of artistic and creative methodologies in activism and development. She has used mediums like theatre, music, art and sports in her work with young girls and women on issues of gender, sexuality and rights.

Big Thank You to Meenu, Shalini, Pooja and Rupsa for the ideas and feedback they shared.

[1] This conversation took place with a 26- year-old man in Jharkhand on 11 March 2013, at an International Women’s Day event that was organised by CREA and Mahila Mandal, as part of CREA’s ‘It’s My Body’ programme. Sanjay [(name changed]) is the captain of the village football team.

[2] It’s My Body- Advancing Sexual and Reproductive Health and Rights of Adolescent Girls through Sports, is a programme led by CREA and co-implemented with ten women-led, community-based organisations in rural and urban areas of Bihar, Jharkhand and Uttar Pradesh.

Think of one regional language word each for the following: Consent. Assumption. Choice. Pleasure. Agency.

These are some of the words which form the foundation of the world of sexual rights. How many did you get?

How does one talk of sexuality? How does one express desire and consent? How does one articulate violation? What do we call the body parts, what do we call ourselves? How do we claim identities or demand space and rights on sexuality? In societies where conversations about sex are silenced, how do we talk about our everyday lives, which are as much about sexual boundaries and norms as they are about the politics of caste, religion, gender, class and so much more besides.

Working on sexuality in local languages is not only crucial but radical. It is radical because it dispels the myth that most of sexuality work happens in the ‘English world’. It is also radical because it demonstrates that no cultures are devoid of sexuality. This means, saying that “we don’t have the language to talk of sexuality” isn’t correct. A friend from Meem[i], Lebanon, berating the mainstream western understanding around the ‘Middle East’ and sexuality, said recently to me, “it’s not that we don’t talk of sexuality, it could be that we just don’t call it sexuality.”

Also, the concept of sexuality isn’t unpacked in a uniform way everywhere. Different meanings are made of it in different contexts. A group of young girls we work with from Jharkhand, when asked what what they understood by sexuality, said in unison,“sexuality means what we like and don’t like in all aspects of life.”

There are many terms, words and connotations that find space in a regional language, but not in English. Hindi offers the space for many terms that connote a cultural construct – such as Hijra. There is no equivalent term in English for Hijra – the only word that comes closest is ‘transgender’, an unsatisfactory translation. Ruth Vanita and Saleem Kidwai’s work[ii]brings together diverse texts that uncover stories of same-sex desire and gender diversity, spanning centuries of the subcontinent’s history and numerous linguistic traditions. Non-English speaking people have not needed English to claim and articulate their realities. Their lives are lived, and desires expressed in a manner they find appropriate for themselves.

In its initial phase of work, sexual rights activists in India were constantly told that poverty was a far more pressing issue than sexuality. These activists brought forth an understanding of intersectionality as a perspective to do any work related to human rights. This perspective also sheds light on access to language in which work is done and the need to work in different local languages is something that became clear fairly earlier on. Since most of the activists who began this work were themselves urban and English speaking, their work would be inaccessible, possibly culturally-alien, if it remained only in the realm of English. Sexuality is a deeply cultural thing – in terms of its specific taboos, the controls, the ways in which it is allowed to be expressed, the breaking of norms, articulation of experiences which are different, naming desire. In India, how can these multilayered cultural manifestations ever be fully expressed in English, without losing its richness?

A few friends decided to say words which we used for our nether regions. Cunt was one of the most used. We felt very empowered, smugly so. At some point one of us said, but what are the non-english words? We came up with a few, choot being one of them. None of us appropriated a single one of those words for ourselves or our amorous moments. We were empowered in English. Elsewhere, we were as good as people who didn’t/couldn’t say cunt.[iii]

One of the challenges of working in Hindi is that sexualised words often also used as slang, and are therefore considered obscene, or are stigmatised. It could feel less personalised. But what is it really that makes us uncomfortable? Could it be that for the English speaking people, our language of thinking limits our expressions around sexuality?

In this work in Hindi, creating new language, and sometimes modifying the existing language becomes crucial to convey meaning.[iv] In the latest edition of the annual Hindi journal on sexual and reproductive health and rights, Reproductive Health Matters (RHM), themed Abortion and Rights, we wanted to highlight the element of ‘right to choice’ for termination of pregnancy.[v] The popular hindi term, garbh paat seemed stigmatised at one level and on further research, it was clear that its literal translation means miscarriage. To keep the right to choice about one’s body and life inextricably linked to induced abortion, we chose to use a lesser used but thought provoking term, garbh samaapan (termination of pregnancy). Such experiments in translation and creation of a new language to talk about sexuality and Sexual and Reproductive Health and Rights (SRHR), keeps our work political.

Another crucial point is about the kind of hindi scholarship around sexuality being created. Is it influenced by the assumption that theory is for English-speakers, while practice is for non-English speakers? This despite the interconnections between practice and theory, and the influence our everyday worlds and their construction have on theory. The diversity in resources available on sexuality in English isn’t the same as that in Hindi. We felt the need for Hindi RHM, a peer reviewed journal, precisely because such theoretical scholarship was not available for Hindi speaking activists. The Institutes on Sexuality, Gender and Rights in Hindi have as much reading and engaging with theory as the English Institutes.

Sometimes popularising certain English terms may make more sense. The term Intersex in Hindi would be antarlingi. Not only does this term in Hindi have no resonance in colloquial Hindi, it is a highly sanskritised way of using language, which we are, very consciously, trying to move away from. The words sex, transgender, surrogate, sex work are some more of such examples.

As part of our sports and SRHR program, It’s My Body, we produced resources for young girls. We wanted to steer clear of the producing material which looks like SRHR outcomes – HIV transmission and menstruation. We realised that we need to think about the kind of language we want to use. We wanted to talk not only of menstrual cycle, but how young girls should have information around their bodies. We wanted to not only talk of how to have safe sex, but that young people should be able to decide who they want to have sex with, when and also have the knowledge, confidence and agency to be able to say yes, no as well as maybe. We decided to use words like sahmati, poorv-anumaan, chaahat, chunaav, haan, naa, pasand –the language used in the work with the groups of young girls.We designed them in a way so girls can keep them hidden, if they needed to; to take out and discuss and read with peers when they felt comfortable.

A conversation on language and sexuality is incomplete without thinking about who is creating the Hindi scholarship in the sexuality world. The people who live in both ‘English and Hindi worlds’ are different from people who live in ‘Hindi worlds’. If we are clear that practitioners are also capable of creating scholarship (as we should be!), a larger objective of creating Hindi scholarship on sexuality must be to put this work in the hands of people for whom English is not the first language. That will alter the canvas of negotiating the language of sexuality.

Meenu Pandey works as the Program Coordinator – Global South Knowledge Resources at CREA. She works on creating scholarship in Hindi on gender and sexuality. She is the co-editor of Close, Too Close: The Tranquebar book of Queer Erotica.

Big thank you to S. Vinita for thinking this through with me and Sanjana and Vrinda for their very useful feedback.

[iii] An old conversation between a group of English speaking friends.

[iv] This blogpost focuses on Hindi as a language but the arguments are relevant for any regional language.

[v] Reproductive Health Matters (RHM) is an independent charity, producing in-depth publications on reproductive and sexual health and rights for an international, multi-disciplinary audience. http://www.rhmjournal.org.uk/ CREA has collaborated with RHM since 2005 to bring out annual editions of the journal in Hindi.

The International Women’s Health Coalition and our amazing partners from around the world came out in force to the UN for the negotiations. Our agenda was clear: push governments to commit to concrete strategies to empower women and girls and end gender-based violence. We would not be silenced. We would not be denied our rights.

We met with instant opposition from conservative governments. Countries such as Iran, Russia, Egypt, and Syria joined with the Vatican to use culture and religion as arguments to deny women their rights. But there can be no excuse to justify violence against women. Consensus was finally reached to loud applause from supportive governments such as the U.S., South Africa, Uruguay, Argentina, Turkey, the Philippines, Norway, Denmark, and even the small island of Tonga! As the document was adopted, hundreds of women’s rights activists streamed into the negotiating room to join in the cheers.

The Commission has released 17 pages of agreed conclusions, which build on the global momentum of the past 20 years and represent an important step forward for women and girls. For the first time at the UN, governments reached consensus that survivors of rape are entitled to emergency contraception to prevent unwanted pregnancy, and to timely and respectful forensic exams to support prosecution. They called for an end to child marriages. They agreed women’s right to control their sexuality is essential to preventing further violence. And they recognized the role that evidence-based sexuality education can play in reducing the harmful gender stereotypes that lead to violence.

Once again, we women have shown we’re an irresistible force. But our work is far from over. Now we must be vigilant to ensure that the agreements made at the UN are put into practice in local communities worldwide. For that to happen, women’s groups must be supported to hold their own leaders to account.

Justices voted 10-5 to issue a status quo ante order enjoining the Palace and concerned agencies from implementing the law.

The order will be in effect for 120 days. Oral arguments on the consolidated petitions will be on June 18.

Despite strong opposition from the Catholic Church, which espouses only natural family planning methods, Congress passed the RH law last Dec. 19. President Aquino signed the law two days later.

The Department of Health (DOH) approved the implementing rules and regulations (IRR) for the law last week. It was scheduled for implementation beginning March 31.

Catholic leaders consider the law an attack on the Church’s core values. The government and even certain Catholic groups say it will help couples choose to space childbirth, plan the size of their families and promote women’s reproductive health.

The Philippines has a population of 94 million and has one of the highest birth rates in Asia.

Those who voted for the issuance of the SC order were Associate Justices Presbitero Velasco Jr., Teresita Leonardo-De Castro, Arturo Brion,

A member of the high court explained to The STAR that majority of the justices saw the need to issue the order “so as to prevent irreparable violations of constitutional rights raised in the petitions, especially if in the end these are established.”

The magistrate pointed out that the order is “preliminary” and the possibility of the high court ruling in favor of the legality of the law still remains.

The SQA order was directed at Executive Secretary Pacquito Ochoa Jr., Budget Secretary Florencio Abad, Education Secretary Armin Luistro, Health Secretary Enrique Ona and Interior Secretary Mar Roxas, who were all named respondents in the case.

The consolidated petitions were filed as early as January by couple James and Lovely-Ann Imbong, non-profit group Alliance for the Family

Eduardo Olaguer of the Catholic Xybrspace Apostolate of the Philippines, former Sen. Francisco “Kit” Tatad and his wife Ma. Fenny

and a group of doctors represented by lawyer Howard Calleja.

The petitioners argued that the RH law “negates and frustrates the fundamental ideals and aspirations of the sovereign Filipino people

as enshrined in the Constitution.”

They cited Article II Section 12 of the Constitution, which states: “The State recognizes the sanctity of family life and shall protect and strengthen the family as a basic autonomous social institution. It shall equally protect the life of the mother and the life of the unborn from conception. The natural and primary right and duty of parents in the rearing of the youth for civic efficiency and the

development of moral character shall receive the support of government.”

Petitioners said at least 11 provisions in RA 10354, which allow couples to choose to suppress life, violate this constitutional provision.

They added that the new law violates constitutional freedom of religion and expression of those who will continue to oppose it and also creates doubtful or spurious rights called reproductive health rights.

Former Akbayan Rep. Risa Hontiveros, an administration senatorial candidate, sought intervention to the case also last January and asked the high court to dismiss six petitions questioning the constitutionality of the RH Law.

Gov’t to defend law

Presidential spokesman Edwin Lacierda said they will observe the SQA order issued by the SC but they are confident that the government will be able to defend the merits of the RH Law.

Speaker Feliciano Belmonte Jr. also said the House of Representatives will respect the order but he remains optimistic that the matter will be resolved soon.

“This (order) is well within the high court’s power and just a temporary setback,” Belmonte said in a statement. “I am hopeful the main issues will be deliberated on so that these can be resolved as soon as possible.”

Albay Rep. Edcel Lagman, the principal author of the RH measure in the House, described the order as only a temporary delay to enable the SC to fully assess the merits and demerits of the pending petitions challenging the law.

“I firmly believe that eventually the constitutionality of the RH Law will be sustained,” Lagman said in a statement.

“The RH advocates had prevailed in the legislative and executive departments, and they will likewise triumph in the high court,” he said.

He said the law is constitutional as the right to life is not defiled, and the right to health not infringed.

Religious freedom is upheld, and parental role in the rearing of the youth is supported by the state under the law, Lagman said.

Meanwhile, the Department of Health (DOH) said they have not received a copy of the order.

“We are calm about it because we have been monitoring the activities of the RH Law opponents,” said DOH Assistant Secretary Eric Tayag, chair of the technical working group that drafted the IRR of the law.

Tayag said the DOH was supposed to publish the IRR anytime now had the SQA order not been issued.

“The publication will be delayed once again. But if we were able to wait for 14 years before the law was enacted, why can’t we wait again? We just hope it won’t take that long,” Tayag said.

“When we were drafting the IRR, we also checked all related laws in the Constitution. We also had three public consultations because we don’t want an IRR that will not be beneficial to women. This is supposed to be our gift to women this Women’s Month,” he said.

Under the IRR, local government units are required to promote both the artificial and natural methods of family planning. This means that banning contraceptives shall be prohibited.

The IRR considers health professionals who cannot deliver reproductive health care services or information because of their religious beliefs as “conscientious objectors,” who will not be penalized but have to refer clients to other health care facilities.

The guidelines also stated that only the modern family planning methods registered with the Food and Drug Administration are “safe, effective, non-abortifacient and legal.”

SC justices pressured?

Reproductive health advocates slammed the SC decision to stop the implementation of the RH Law.

In a phone interview, Philippine Legislators Committee on Population and Development (PLCPD) executive director Romeo Dongeto said they did not expect the ruling.

“This is an affront to the intention of our lawmakers to improve maternal and reproductive health of Filipino women,” Dongeto said.

“The question is, ‘Did the SC justices succumb to the pressure of the Catholic Church?’” he said.

As one of the strong supporters of the RH Law, Dongeto said the PLCPD believes all issues raised against the measure including medical, scientific and moral questions, have been addressed.

“It’s unfortunate that the SC issued a 120-day status quo ante order against the RH Law. We badly need the law to reduce unintended pregnancies and maternal mortalities in the country,” Padilla said.

“In our interviews with poor women in Manila last November, we found 65 percent of them were candidates for ligation, meaning, they have way surpassed their desired number of children,” she said.

Padilla said 11 Filipino mothers die from pregnancy and childbirth complications every day.

TRO welcomed

On the other hand, Sen. Vicente Sotto III, who opposed the RH measure, yesterday welcomed the SC order, saying the Supreme Court knows what’s best for the country.

Zambales Rep. Mitos Magsaysay added that the SC might have found some merit in the petitions against the RH Law.

“The high court must have thought that there are indeed provisions in the law that are illegal or in conflict with existing laws and the Constitution. I strongly suggest that its authors make the necessary amendments or repeal it outright,” Magsaysay said in a telephone interview.

Sorsogon Bishop Arturo Bastes said that the issuance of an SQA order was an indication that the magistrates were listening to the objections of the Catholic Church.

He, however, said the people should not be complacent since their struggle is not yet over and the RH Law can still be implemented.

Catholic Bishops’ Conference of the Philippines-Episcopal Commission on Family and Life executive secretary Fr. Melvin Castro said that the SC has heard their prayers and they were pleased to know this even if it was just a temporary victory.

He also said this serves as a challenge to the voters to elect candidates who give importance to life and family.

United Nationalist Alliance (UNA) senatorial candidate Nancy Binay, for her part, said the high tribunal’s decision will give advocates and opponents of the RH Law the opportunity to air their positions.– With Sheila Crisostomo, Jose Rodel Clapano, Delon Porcalla, Evelyn Macairan, Paolo Romero, Helen Flores, Christina Mendez, AP

At the People’s Health Assembly 3 held in Cape Town, South Africa in July 2012, People’s Health Movement committed to build a campaign on gender issues through initiating separate circle on the “Global thematic campaign on Genders” within the PHM right to health campaign. Through the online correspondence in these last few months, a general view of expanding the gender circle has emerged, especially regarding specific themes of gender, equity, and violence, Sexual and Reproductive Health Rights and Reproductive Justice.

Why a Global thematic campaign on Gender

We, at PHM believe that Health Rights including Sexual and Reproductive Health Rights must be located within a perspective that recognizes social determinants of health, and universal health entitlements/access to healthcare. The framework should address the oppressive structures of neo-liberal globalization, capitalism, poverty, patriarchy, privatization of essential services, imperialism, militarization, fundamentalisms, heteronormativity, racism, casteism and ableism, which not only exacerbate poor physical, sexual, reproductive and emotional health for women and young girls but also disadvantage them in accessing health-care.

We are only too aware of how gender oppression is intricately linked to other systems of oppression and PHM’s agenda should be to make a conscious effort to create space and visibility for some such concerns that can often be observed to be marginalized even within progressive, rights movements. While they assume different forms in different contexts and social realities, issues of ability/disability, sexuality, health in the context of conflict, state sponsored coercive population policies, gender based violence, non-coercive access to contraception and abortion, and especially the rights of sex workers, transgender, HIV positive individuals in relation to all the above are sparsely raised on the public health platforms and health movements across the world.

There is a cyclical relation between violence and ill-health; both influence each other, yet gender based violence is rarely addressed as a human rights or public health issue. That violence takes varied forms and that gendered notions make certain peoples particular targets is a question of political violence that a movement like PHM needs to urgently address.

Historically, as we know that women’s ability to make choices and exercise autonomy in matters of sexuality and reproduction has been conditioned and constrained by economic, political, religious and cultural patterns, responding to a model of prescriptive ‘normality’ and disallowing any kind of behavior which deviates from this. The relegation of women’s health to maternity and family planning on the one hand and the concerted attack on women’s reproductive and sexual rights on the other are serious violations of women’s autonomy, personhood, dignity and human rights.

Throughout the world, society, law and cultural norms have repressed any behaviour that could challenge this prescriptive reproductive role of women. Reproduction itself becomes a site of coercion and social inequality, being regulated by morality, class, caste, race hierarchies and community. It is the same ideas of gender roles, relations and sexual division of labour that result in coercive structures for women, and further marginalize several persons who go against the existing heteronormativity.

As an object of policy, sexuality and sexual rights have generally been considered as an ‘unimportant’ and secondary issue. Women’s movements have also only gradually given space to these debates. That sexual rights for all are essential for better physical, mental and emotional health is a perspective that needs a much stronger acknowledgement and activism by both the state and social movements.

Within the health care systems, health professionals need to be sensitised in order to address all forms of violence and discrimination on the basis of gender within the private as well as public spheres. Health rights can be enjoyed by all and accessed at all times only if the rights of those who occupy low rungs in the gender hierarchy have secured rights in all spheres.

PHM is well-placed to address components of policy advocacy, capacity building, knowledge creation and health systems engagement within this umbrella framework. The need is for us to foreground this perspectives in our strategies. We can hold capacity building and advocacy initiatives for SRHR, violence There is a need to conceptualize the campaigns/circles in a way that we understand the common systems of oppressions and gender hierarchies and are able to equally visiblize and address concerns of all those who are marginalized, exploited and discriminated against on the basis of their gender identities and sexual behaviour.

The thematic Circle will Insert all these concerns within the People’s health movement by- informing the PHM mandate and the campaign for Health For All and vis-à-vis gender.PHM will provide a platform for women across the world to articulate the above concerns as well as to share and learn from each other the creative struggles waged by people, especially by women, against injustice and inequality.

PHM global has already been engaged with many networks such as WGNRR, IWHM, ARROW, SAMA, WISH to name a few. We would like to welcome and invite networks/organisations, coalitions to join and collaborate with us on this initiative. Together we can strategise for a better world that is founded on social justice, non-discrimination and equal opportunity for all people.

FREETOWN, 27 November 2012 (IRIN) – The new government is responding positively to health workers and youth groups who have long called for a change in the 1861 law banning abortion except in exceptional circumstances.

A draft law which would make abortion legal under certain conditions, is currently waiting to be passed by parliament following the 17 November elections, according to Sas Kargbo, director of Reproductive Health at the Health Ministry.

“The present laws are outdated and violate the rights of the women of Sierra Leone,” said Al Saccoh, coordinator of a youth network called the National Youth Coalition of Sierra Leone, adding that the current law contradicts international covenants on human rights that Sierra Leone has signed since 1861.

Campaigners say the unavailability of cheap and safe abortions is leading to severe health risks for women and girls and pushing up the maternal mortality rate.

Brima Kamara, advocacy manager at the Planned Parenthood Association of Sierra Leone, told IRIN: “Because there is no legal framework that gives women the right to choice governing abortion, the present law is killing women.”

Sierra Leone has one of the world’s highest maternal mortality rates: 890 women die for every 100,000 live births.

It is not clear how many women seek abortions in Sierra Leone each year as so many of them do so clandestinely, but reproductive rights NGO Marie Stopes International estimates at least 40,000 women and girls in Sierra Leone had abortions in 2011.

According to the UN Population Fund (UNFPA), some 250,000 children across the globe lose their mothers to abortion-related deaths.

Quacks
The problem is most women seeking an abortion will turn to uncertified doctors or quacks who perform cheap abortions, as few can afford the SL 200,000 (US$46) fee that a certified doctor would charge.

Methods used by quacks include giving women detergent to swallow, administering high doses of aspirin or antibiotics, or using native roots and herbs, according to Williamson Taylor, a gynaecologist at the Princess Christian maternity hospital in the capital, Freetown.

Taylor said he often tends to patients who have undergone botched abortions. Most of them arrive in a state of severe pain, or have heavy bleeding, or may have infections linked to perforations of the uterus, intestines or abdominal cavity.

“I have performed many surgical operations due to abortion complications in young girls,” he told IRIN. “Cassava sticks and other objects that they use to abort a pregnancy are a very crude method and usually perforate the womb or the intestines.”

Some 4-10 percent of women who have a medical abortion will need to have a surgical procedure following it, to remove the remaining tissue, said Sarah Koroma, delivery manager at the Planned Parenthood Association clinic at West Street in Freetown. Uncertified doctors lack the training or equipment to do this.

But it is hard to find certified doctors who are willing to perform the procedure – many fear legal redress. “The present law does not favour us as qualified doctors. As such, there is constant fear. I perform abortion for humanitarian purposes where the life of the girl or woman is at dire risk. It’s important that the present law is reformed to create accessibility to abortion services as a right, without fear,” Taylor told IRIN.

Most cases require consent from the partner of the woman, or in the case of a minor, her parents, which puts off many would-be patients.

Reproductive health agencies will also perform abortions if the pregnancy is seen to put the life of the patient at risk. A nurse at one practice told IRIN: “It’s not yet legal, so we do it within the parameters of the present law.”

Pressure mounting
But pressure among many sections of society is mounting for a change in the law. Many doctors who have experienced first-hand the implications of unsafe abortions support a new law. “We have to give people choice. Sex is an unavoidable thing so we must make it safe for people who want to have an abortion in a country like Sierra Leone,” said Taylor.

Ex-Minister of Health and Sanitation Zainab Hawa Bangura would not be pinned down, but told IRIN: “Improvements in laws and policies, and a more responsive approach to the reproductive health needs of women is needed in Sierra Leone.”

In a recent county-wide Ministry of Health-led survey of health workers and legal professionals on attitudes to abortion, most respondents favoured a review of the law, calling for the government to liberalize abortion as part of its commitment to reduce maternal mortality rates.

However, many religious leaders are not in favour, and see imminent change as destroying the moral fabric of Sierra Leonean society. A group of Islamic clerics recently came forward to announce they would accept abortion if it took place within the first four months of pregnancy and if the mother’s life was in danger.

Family planning
Legalizing abortion, however, is just one step in a much more complicated puzzle, say campaigners and health workers.

Access to family planning services remains very poor for youths, especially girls and women.

Sierra Leone has high teenage pregnancy rates due to poor education standards for girls; initiation rites into secret societies which make even young girls eligible for marriage; high levels of sexual violence; low access to contraception; and low awareness of family planning methods, according to reproductive rights agencies.

A number of agencies (including UNFPA, Marie Stopes, Planned Parenthood, and the UK Department for International Development) are trying to boost access to quality family planning services for Sierra Leoneans of all ages, across the country. UNFPA launched a family planning campaign in July 2012.

But while attitudes towards family planning are shifting, particularly among urban women, say health workers, they will not change their behaviour unless access to services becomes much more readily available. Too often health clinics remain under-stocked, particularly in rural areas.

“The use of contraceptives must be pushed aggressively in Sierra Leone to help reduce the huge number of young girls seeking abortions in secret,” concluded Taylor.

Latest publication on “WHO recommendations for the prevention and treatment of postpartum haemorrhage” by WHO, 2012.

“Every minute around the world 380 women become pregnant,

190 women face unplanned or unwanted pregnancies,

110 women experience pregnancy related complications,

40 women have unsafe abortions,

1 woman dies.”

The World Health Organization states that every minute, at least one woman dies from complications related to pregnancy or childbirth – that means 529 000 women a year. Unavailable, inaccessible, unaffordable, or poor quality care is fundamentally responsible.

Find the latest recommendations below.

The report in its guideline development method, section of the report reads out as follows: “The scientific evidence for the recommendations was synthesized using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. For each of the previous WHO recommendations on PPH (2007 and 2009) and for all the newly-added questions, evidence profiles were prepared based on 22 up-to-date systematic reviews. The revised and new recommendations were developed and adopted by an international group of experts who participated in the WHO Technical Consultation on the Prevention and Treatment of PPH, held in Montreux, Switzerland, 6–8 March 2012. The WHO Technical Consultation adopted 32 recommendations and these are shown in Boxes A, B and C. For each recommendation, the quality of the supporting evidence is graded as ‘very low’, ‘low’, ‘moderate’ or ‘high’………………”

Box A: Recommendations for the prevention of PPH

1. The use of uterotonics for the prevention of PPH during the third stage of labour is recommended for all births. (Strong recommendation, moderate-quality evidence)

3. In settings where oxytocin is unavailable, the use of other injectable uterotonics (if appropriate ergometrine/methylergometrine or the fixed drug combination of oxytocin and ergometrine) or oral misoprostol (600 μg) is recommended. (Strong recommendation, moderate quality evidence)

4. In settings where skilled birth attendants are not present and oxytocin is unavailable, the administration of misoprostol (600 μg PO) by community health care workers and lay health workers is recommended for the prevention of PPH. (Strong recommendation, moderate quality evidence)

5. In settings where skilled birth attendants are available, CCT is recommended for vaginal births if the care provider and the parturient woman regard a small reduction in blood loss and a small reduction in the duration of the third stage of labour as important (Weak recommendation,

8. Early cord clamping (<1 minute after birth) is not recommended unless the neonate is asphyxiated and needs to be moved immediately for resuscitation. (Strong recommendation, moderate-quality evidence)

9. Sustained uterine massage is not recommended as an intervention to prevent PPH in women who have received prophylactic oxytocin. (Weak recommendation, low-quality evidence)

14. If intravenous oxytocin is unavailable, or if the bleeding does not respond to oxytocin, the use of intravenous ergometrine, oxytocin-ergometrine fixed dose, or a prostaglandin drug (including sublingual misoprostol, 800 μg) is recommended. (Strong recommendation, low-quality evidence)

15. The use of isotonic crystalloids is recommended in preference to the use of colloids for the initial intravenous fluid resuscitation of women with PPH. (Strong recommendation, low-quality evidence)

16. The use of tranexamic acid is recommended for the treatment of PPH if oxytocin and other uterotonics fail to stop bleeding or if it is thought that the bleeding may be partly due to trauma. (Weak recommendation, moderate-quality evidence)

18. If women do not respond to treatment using uterotonics, or if uterotonics are unavailable, the use of intrauterine balloon tamponade is recommended for the treatment of PPH due to uterine atony. (Weak recommendation, very-low-quality evidence)

19. If other measures have failed and if the necessary resources are available, the use of uterine artery embolization is recommended as a treatment for PPH due to uterine atony. (Weak recommendation, very-low-quality evidence)

20. If bleeding does not stop in spite of treatment using uterotonics and other available conservative interventions (e.g. uterine massage, balloon tamponade), the use of surgical interventions is recommended. (Strong recommendation, very-low-quality evidence)

21. The use of bimanual uterine compression is recommended as a temporizing measure until appropriate care is available for the treatment of PPH due to uterine atony after vaginal delivery. (Weak recommendation, very-low-quality evidence)

22. The use of external aortic compression for the treatment of PPH due to uterine atony after vaginal birth is recommended as a temporizing measure until appropriate care is available. (Weak recommendation, very-low-quality evidence)

23. The use of non-pneumatic anti-shock garments is recommended as a temporizing measure until appropriate care is available. (Weak recommendation, low-quality evidence)

24. The use of uterine packing is not recommended for the treatment of PPH due to uterine atony after vaginal birth. (Weak recommendation, very-low-quality evidence)

25. If the placenta is not expelled spontaneously, the use of IV/IM oxytocin (10 IU) in combination with controlled cord traction is recommended. (Weak recommendation, very-low-quality evidence)

26. The use of ergometrine for the management of retained placenta is not recommended as this may cause tetanic uterine contractions which may delay the expulsion of the placenta. (Weak recommendation, very-low-quality evidence)

27. The use of prostaglandin E2 alpha (dinoprostone or sulprostone) for the management of retained placenta is not recommended. (Weak recommendation, very-low-quality evidence)

28. A single dose of antibiotics (ampicillin or first-generation cephalosporin) is recommended if manual removal of the placenta is practised. (Weak recommendation, very-low-quality evidence)

Box – C: Organisation of Care

29. The use of formal protocols by health facilities for the prevention and treatment of PPH is recommended. (Weak recommendation, moderate-quality evidence)

30. The use of formal protocols for referral of women to a higher level of care is recommended for health facilities. (Weak recommendation, very-low-quality evidence)

31. The use of simulations of PPH treatment is recommended for pre-service and in-service training programmes. (Weak recommendation, very-low-quality evidence)

32. Monitoring the use of uterotonics after birth for the prevention of PPH is recommended as a process indicator for programmatic evaluation. (Weak recommendation, very-low-quality evidence)

We would like to invite you or your organization to endorse this statement (at bottom of this email), which will be presented to the organisers prior to the Summit.

To endorse this statement, please send the following information to CRR’s Kate Meyer (kmeyer@reprorights.org).

Name of organization or individual (please specify which):

Country:

Name and email of contact person:

Please also circulate this statement to your contacts and networks. The deadline for endorsements is Monday, 11 June 2012.

* We will circulate the statement again after endorsements have been received.

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Rights must be at the centre of the Family Planning Summit: Civil Society Declaration

We, civil society organizations working to promote women’s and young people’s human rights, call on world leaders on the eve of the “Family Planning Summit”, hosted by the UK Government and the Bill and Melinda Gates Foundation, to ensure that sexual and reproductive health and rights are at the centre of all efforts to meet reproductive health needs, including family planning.

Contraceptive information and services – “family planning” – form an essential part of the health services that women need throughout their lives. Any steps to increase demand for contraceptives must actively support efforts to improve comprehensive and integrated sexual and reproductive health. Contraceptives must be provided through primary healthcare, with full regard for women’s human rights and the specific needs of young and unmarried women and other groups.

Our experience, built over decades of work around the world, has taught us that the failure to take actions guided by women’s human rights – to health, to life, to live free from discrimination among others – can have devastating consequences. Policies that accept or tacitly condone forced sterilization, the coercive provision of contraceptives, and the denial of essential services to the young, poor and marginalized women that need them every day have violated, and continue to violate, women’s human rights.

Nearly twenty years ago, governments at the International Conference on Population and Development agreed that respect for women’s reproductive autonomy is the cornerstone of population policy. Any return to coercive family planning programs where quality of care and informed consent are ignored would be both shocking and retrograde. The Family Planning Summit must ensure that the clocks are not put back on women’s rights: women’s autonomy and agency to decide freely on matters related to sexual and reproductive health without any discrimination, coercion or violence must be protected under all circumstances.

In order to expand contraceptive access with full respect for women’s human rights, we urge governments, donors and other actors supporting the Family Planning Summit to:

· Take all possible measures to ensure that this initiative is designed with quality of care and human rights at its core, so that no coercive measures are introduced in the provision of contraceptives;

· Ensure that meaningful participation by women, including young women, is built into all stages of program design and implementation to ensure that services are responsive to their needs and to prevent any human rights violations;

· Ensure that the provision of contraceptives is integrated into existing and new sexual and reproductive health services, and that a full range of contraceptive methods is offered;

· Design and implement a system for monitoring, evaluation and accountability to track and measure its impact on the rights of women as this initiative is rolled out, and urgently make necessary corrections should violations come to light;

· Commit to tackling the existing legal and policy barriers that hinder access to contraceptive information and services, without which efforts are likely to be ineffective and exacerbate disparities in access.

Constitutes yet another manifestation of the conservative politics that does not view women as equal individuals!

Prime Minister Erdogan’s statements in the last week of May 2012 have revealed that plans to ban abortion have been underway for some time now. Experience from the global arena illustrates that this lethal attempt, which has no scientific backing, will not reduce abortion rates; instead it will only lead to unsafe abortions and increase maternal mortality.

FREELY CHOSEN SAFE ABORTION IS A WOMAN’S RIGHT TO LIFE; IT CANNOT BE RESTRICTED, IT CANNOT BE BANNED!

According to data from the World Health Organization, tens of thousands of women across the world die every year as a result of unsafe abortions. In Turkey, establishing the legal grounds for women to end unwanted pregnancies on demand has contributed to the decrease in maternal mortality, which dropped from 250 to 28 in every 100,000 live births from the 1970s to the mid-2000s. There is no data indicating that abortion is on the rise in Turkey; on the contrary, while 18 pregnancies out of 100 ended in abortion in 1993, this ratio was down to 10 percent in 2008. In an era where 26 countries have taken steps to remove obstacles that hinder access to abortion between 1994 and 2011, efforts to ban or restrict it in Turkey are unacceptable. Restricting the right to access safe abortion services and making them available only when required by medical conditions or instances of rape works to marginalize women’s fundamental bodily and sexual rights, and reduces the enjoyment of this right to circumstances of necessity.

We object to risking women’s rights to health and life by restricting or banning abortion instead of encouraging free, easily accessible, high quality birth control methods. Abortion is not only a freedom of choice, but a vital social right. The right to abortion that is on demand, free-of-charge, accessible, safe, and legal, is also a right to life. Forcing women to take life-threatening risks is nothing short of murder.

THE RIGHT TO SAFE ABORTION IS AN INDIVISIBLE PART OF WOMEN’S RIGHTS TO MAKE DECISIONS ABOUT THEIR BODILY AND REPRODUCTIVE RIGHTS!

Women’s right to sexual and reproductive health includes having control over their own bodies and access to safe abortion; limiting these rights is an open violation of fundamental human rights and women’s human rights. In accordance with its domestic legislation and the international conventions it is party to, Turkey is under obligation to provide adequate, comprehensive, and accessible sexual and reproductive health services. In Turkey, child marriages, forced marriages, women’s murders, rapes, and morality-based repression mechanisms have all become normalized. The responsibility for birth control has been left primarily to women. However, in a country where contraceptives are not easily accessible, withdrawal is the most prevalent form of birth control, female employment rates continue to drop and female poverty is rapidly increasing, restricting or banning women’s right to on demand pregnancy termination is an act of blatant discrimination that will push women to seek unsafe abortions.

WE REJECT THE ATTACKS ON HUMAN RIGHTS THROUGH MILITARIST AND DISCRIMINATORY DISCOURSES AND PRACTICES!

By saying “Every abortion is an Uludere,” PM Erdogan equated women’s enjoyment of their bodily rights with killing people in a bombardment attack. This is a discriminatory and militarist statement that calls to question the human rights of both Kurds and women, whereas the primary responsibility of any state should be to ensure its citizens lead a decent life, and to guarantee equal rights and freedoms to all.

According to Article 16.1.e of the Convention on the Elimination of All Forms of Discrimination against Women-to which Turkey is a proud signatory-women have the right to “decide freely and responsibly on the number and spacing of their children.” The current governmental initiative to ban abortion is simply another manifestation of the ongoing misogynist mentality that ignores women’s right to make decisions on matters that concern their bodies, sees women’s primary reason for existence as the continuation of the species, and constructs neoliberal population policies based on women’s bodies.

A decision to ban abortion will constitute an open violation of the right to life for millions of women, and the right to live with dignity for men, women, and children alike.

We, the undersigned organizations, demand that the process initiated to ban abortion and the politics of the Prime Minister and the Government of Turkey that target women’s bodies be ceased IMMEDIATELY!!